Real-world evidence positions nirsevimab ahead in infant RSV prevention

Respiratory syncytial virus (RSV) remains a leading cause of hospitalisation and severe lower respiratory tract infection (LRTI) in infants worldwide. [Lancet 2022;399:2047-2064; Lancet 2017;390:946-958] In recent years, two immunoprophylactic strategies have become available to protect infants, namely maternal immunisation with the RSV prefusion F (RSVpreF) vaccine and passive immunisation of infants with the long-acting monoclonal antibody nirsevimab.

Until recently, real-world comparative evidence between these approaches was limited. However, several new population-based studies now provide important clarity, alongside emerging evidence indicating higher effectiveness and durability of nirsevimab protection against RSV-associated LRTI. Two independent evaluations from France and the US directly compared the effectiveness of nirsevimab and maternal RSVpreF vaccination against RSV-related hospitalisation and severe outcomes. A third follow-up study from Spain examines the population-level benefits associated with nirsevimab beyond the first 6 months after administration. [JAMA 2025:e2524082; JAMA Pediatr 2025:e255778; Lancet Infect Dis 2026:S1473-3099(25)00742-X]

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